Some Things to Say

We’re not idiots. Everyone knows how to communicate. You just flap your jaws and blow.

In this business, though, we often find that it’s not enough to communicate; we have to do it efficiently. Likewise, it’s not enough to ask the right questions eventually. We need to do it promptly, because we’re not going to be here all day.

Heck, never mind efficiency. Sometimes there’s just a right thing to say, and everything else is wrong things. As Mark Twain put it, it’s the difference between the lightning-bug and the lightning.

So when you find a good bunch of words, you hold onto it, because like a master key, it’ll come in handy again. Here are two little phrases that everyone should have in their toolbox.

Has anything been bothering you lately?

I borrow this from Thom Dick, who suggested instead “Have you been upset about anything lately?” This is good, but to my ear leans more toward psychological troubles — very legitimate, but perhaps not what you’re after.

The patient has chest pain. Okay. Abdominal pain. Difficulty breathing. Clicky elbow. Can’t pee. So you assess their complaint from every angle, real and metaphoric, and you see what there is to see about it. But what’s the context? Is this the final stage of a grab-bag of other problems? Before it was abdominal pain, was there nausea and discomfort? Have the past few days produced a gradually increasing malaise? Is that onset truly sudden, or were there precursors?

Forget all that. Did your cat just get run over? Is your insurance refusing your reimbursements? Did your medication run out last week and you haven’t been able to afford to refill it? Are you living on ramen noodles and water?

Has anything else been bothering you? We can’t list every malady, but this question encompasses them all, and it can reveal entire storylines you wouldn’t have learned without an open-ended query. Patients have a habit of not mentioning anything that doesn’t seem directly related to their chief complaint, but those blips can make or break a clinical picture. I never call a history complete without asking it once.

How can I help?

Patients have a lot of complaints. Sometimes it’s the very reason they called you. Sometimes it’s just a complaint. They’re sick. Stuff hurts. Feels bad. Has problems.

They may share these complaints with you. And you may be able to help. Chest pain, you say? Why, I have just the morphine for that!

The trouble is, sometimes we’re not sure if we can help. Or it doesn’t seem like we can. Chest pain’s one thing. But what can you do when they complain of feeling “awful”? What about an uncomfortable stretcher — sure, let me just grab the plush memory foam? Heck, on my BLS truck, we don’t even have the morphine. We’re not magicians here.

But if you’re drawing a blank, try the wild card: ask!

Hey, sorry you’re having problems. How can I help? Often they have a solution. They’ve dealt with their problems for longer than you have. Next time, maybe you’ll have that answer on tap. But you don’t have to know all the answers; you just have to be able to ask. Funny thing, too; even when you really can’t do anything, they’re glad you cared enough to try. Sure is better than just sitting there trying to ignore their whining.

How can I help? Hey — isn’t that our whole business? They give us textbooks on how we can help. But sometimes helping’s easier than a CPAP or a trauma alert. Sometimes we can cheat, because the answer’s up for grabs. You just gotta ask.